Public hospital or private?

Having a baby means a choice between public and private hospital. Here are the ins and outs of both options.

When deciding whether to go public or private, you need to weigh up what you want out of the birthing experience, as well as what you can afford and if your health cover will absorb the costs of going private.

The hospital booking

Public: Due to high demand, some hospitals only accept bookings from local women. "Different hospitals have different policies. Some have quotas and some have zoning restrictions which might exclude some women," explains Dr Alexis Shub from the University of Melbourne's Department of Obstetrics and Gynaecology, and Mercy Hospital. Dr Shub advises that you make your hospital booking as soon as you find out that you are pregnant.

Private: If you have a private obstetrician, where you give birth will be determined by where the doctor has visiting rights. Or you can choose the private hospital and then find out which obstetricians practise there.

Type of care

Public: The public system offers shared care, team midwifery, birth care centres and obstetrician care. It's also possible to book a private obstetrician in a public hospital. In shared care, the woman's GP looks after her in conjunction with visits to the hospital. Under midwifery care, the woman gets to know a small group of midwives during her antenatal visits and one of them is present for the birth.Women with low-risk pregnancies can opt for birth centre care, while those with health risks, such as diabetes, can see hospital obstetricians.

"The statistics tell us the chance of intervention is doubled with a private obstetrician," says Hannah Dahlen, president of the Australian College of Midwives. If you live outside a main city, your options are limited. Dr Nola Maxfield, Rural Doctors Association president, says: "There aren't many private hospitals in the bush but you'd get better continuity of care because in rural areas, there are only a handful of doctors doing the birthing work."

Private: All appointments throughout the pregnancy are conducted in the obstetrician's surgery and they become more frequent as the pregnancy progresses. "If you have a fear over something going wrong, a private obstetrician becomes very important," Dahlen says. "The advantage is that if something does go wrong, you will have someone you know looking after you."

Many obstetricians now work in teams to have some time off, so there's no guarantee your obstetrician will attend the delivery. "You need to ask if they share cover with members of a group practice, whether you can meet the other members and decide whether you will feel comfortable with a different obstetrician," says Caroline de Costa, professor of obstetrics and gynaecology at James Cook University in Queensland.

In a natural birth, the obstetrician often arrives in the final stage of delivery and a hospital midwife looks after you throughout labour. If you are having a caesarean, your obstetrician will usually perform the procedure. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists website can help you locate a specialist - click here to check it out.

Facilities and services

Public: You're more likely to share a room if you go public, though maternity wards in public hospitals often have private rooms. In some cases, such as the Royal Women's Hospital in Sydney, there's no room service - all meals are served in a communal dining room and it's up to you to get your own food during the designated time.

Private: Private hospitals often have night nurseries where they will care for the newborn while mum catches up on some sleep and recovers from the birth. Some offer spa baths in modern, newly refurbished private rooms that look more like a hotel room, though there's no guarantee you won't have to share. Often your partner can stay too (for an extra fee) and some private rooms even have double beds.

Increasingly, private hospitals are teaming up with luxury hotels and are sending new mums who had a smooth delivery to recover in a hotel suite, complete with bathrobes, harbour or city views, room service three times a day from a restaurant menu, in-house movies and limousine transfers equipped with a baby capsule. It doesn't cost any extra and private health funds pick up the tab - it's cheaper for them than a hospital stay.

Length of stay

Public: The length of stay varies from hospital to hospital, but generally women who have had a caesarean section will stay five days. Vaginal deliveries stay two or three days, and women who deliver in a birthing centre are usually discharged after 24 hours and encouraged to visit their GP within a week of coming home.

Private: Women with vaginal deliveries usually stay four nights and women who have had a caesarean stay five nights.

Cost

Public: There are usually no costs involved in having a baby through the public system. If you choose shared care with your GP and they do not bulk-bill, you will have some limited expenses. Ultrasounds, blood tests and pathology costs are covered by the hospital, which also provides education classes. If you book a private obstetrician to attend to you in a public hospital, you still pay the hefty obstetrician's fees but it tends to be cheaper than staying in a private hospital.

Private: Obstetricians' charges vary from $2000 to $10,000 (part of which can be covered by private health insurance) and they will refer you elsewhere for ultrasounds and blood tests, which can add several hundred dollars to your total bill. You will also receive separate bills from the anaesthetist if you require one and from the pharmacy if you receive any medication. Additional costs include the paediatrician who checks your baby in the hospital and any prenatal classes you participate in.

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Latest Comments ( 5 )

I really really wish I had read this before getting pregnant. I went private because I thought that was the way to go if you have insurance also my parents pressured me and I was very uninformed. Anyway its cost me thousands in a time when we are almost broke! Also I didn't realise at the beginning that different obgyns charged different amounts and that you should shop around. I think next time I'll just go public!

Hi,I am student overseas, I am pregnant and I dont have money to go a private hospital, I need a GP to refer me to the Mater Hills Hospital and also a blood test and all of the exams, I dont have enought money and I am really worry about my baby. Do you know where I can find a good GP and economic in Brisbane?

Fantastic article and very informitive! My partner and I are hoping for a baby in the next year or so and I was considering getting private health cover but I didnt realise with private you still incur alot of other charges. Will definitely be going public now.

I am 27, mother of 2 boys and went through the public system for both my boys. I have private health insurance but the advantages of the public system completely out weighed that of private. I attended a group midwifery practice run through the Mater Mothers Hospital in Brisbane and it is a brilliant set up. A very personal experience and 6 weeks of home visits after the birth (FREE!) by your own midwife - tell me what obstetrician offers that!

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